The psychiatrist and psychoanalyst Stanford Bourne, who has died aged 92 of congestive cardiac failure, broke the silence in the 1960s surrounding the anguish of stillbirth. His work opened up discussion, addressed medical bias, and guided doctors and midwives towards a more compassionate approach.
In the 60s, 18,000 women a year had a stillborn baby, but it was cloaked in secrecy. Well-meaning staff quickly removed babies before parents could see, name or hold them, and they were “disposed of” – cremated or buried with nothing to mark the spot. Parents were expected to stifle their grief and often urged to “try for another”.
Bourne worked at the Tavistock clinic, London, throughout his career until 1993. He became curious about stillbirth in 1960 when a woman in his care was severely depressed following the death of her baby. Searching for the best therapeutic approach, he combed psychiatric and medical literature, but found nothing.
It would seem psychological issues following stillbirth was a professional blindspot. He was initially exasperated, but his psychoanalyst training told him he was on to something: “I slowly realised this was perhaps the most interesting thing I had stumbled into.”
Bourne canvassed 100 GPs who had recently attended a stillbirth about the experience and its psychological effects. For comparison, he asked the same questions of 100 GPs who had delivered live, healthy babies. Around 90% of the GPs attending the live births responded, giving detailed responses about the new mother’s state of mind, whereas the doctors attending the stillbirths did not answer, or gave terse, one-word replies. Bourne later wrote: “The stillbirth doctors seemed driven to not-knowing, not-noticing and not-remembering anything.”
The alienation of doctors from stillbirth was further underlined when the Lancet and the British Medical Journal would not publish Bourne’s findings. However, finally, in 1968, he got his research into print as: The Psychological Effects of Stillbirths on Women and Their Doctors (published in the Journal of the Royal College of General Practitioners). It was the first study of its kind and revealed not only that stillbirth was hugely traumatic for women, but their relationship with their doctor could suffer and break down because doctors had such difficulties with the issues.
Bourne and the psychotherapist Emanuel Lewis collaborated closely over the next 25 years. They studied the way stillbirths were managed in obstetric units and found shocking neglect of women’s emotional needs. They wrote and spoke about stillbirth and grief, helping to change the culture. Gradually midwives and obstetric doctors started to allow parents to hold and name their dead child, and to have a funeral.
First-hand accounts started to come out in the media, notably Bel Mooney’s article I Could Not Cry in the Guardian in 1976, and in 1978 bereaved parents set up the support organisation Sands (Stillbirth and Neonatal Death Society). In the same year the Registrar General changed the word “disposal” to “burial” on stillbirth forms. To summarise how far they had come, in 1992 Bourne and Lewis produced their book Psychological Aspects of Stillbirth and Neonatal Death.
Interest in doctors’ psychology and unconscious bias was a theme elsewhere in Bourne’s work. He ran Balint groups (named after the psychoanalyst Michael Balint) for GPs at the Tavistock clinic, in which doctors discussed a medical issue, aiming to have deeper self-awareness and better interactions with patients.
Bourne ran Balint groups for other professions including physiotherapists and wrote about the complex tangle of feelings the physios and their patients had in his book Under the Doctor (1981).
He took on another medical conspiracy of silence in the shape of distinction awards. Committees met in secret to recommend medical consultants for awards, which made a massive difference to their salaries. In 1980, awards ranged from an extra £3,720 a year to more than £18,000. In a coffee break, Bourne persuaded his colleagues at the Tavistock to divulge whether or not they had an award, and was shocked at how few had one.
In papers written with Peter Bruggen from 1975 to 1982 he flagged up how unfair the system was. For example, more than 60% of consultants in surgery and cardiology had awards in 1980 compared with 24% in geriatrics and mental health, and only one woman had an A+ award in the UK compared with 119 men. Bourne said: “We should like the system abolished because it remains immutably unfair, divisive, and, in its secrecy, contemptible.” The system was not abolished, but their work was an essential step towards it becoming more transparent.
Stanford Bourne, who was always known as Sandy, was the younger of two sons of Jack, a tailor, and Rachel (nee Oster), a teacher. They were Jewish migrants from Poland who had set up home in Tottenham, north London, and in 1934 anglicised their name from Baum to Bourne.
With the second world war, Sandy was evacuated to Virginia Water, Surrey, and attended Windsor grammar school. His elder brother, Harold, who also became a psychiatrist, encouraged him to take up medicine. Bourne studied at University College London, qualifying in 1952. He chose to specialise in psychiatry, studying at the Maudsley hospital in south London, and then trained with the distinguished psychoanalyst Hanna Segal, before becoming a consultant at the Tavistock.
In 1958 Bourne married Judith Barnett, a violin teacher from New Zealand. They set up home in north London and had two children, Lucy, who died in 1986, and Charles. In later life, Bourne enjoyed spending time in his cottage in France and playing the piano and tennis.
He is survived by Judith, Charles, and his grandchildren Charlotte and Henry.